Abstract
BACKGROUND AND OBJECTIVE: The reported impacts of the COVID-19 pandemic on child maltreatment in the United States have been mixed. Encounter trends for child physical abuse within pediatric emergency departments may provide insights. Thus, this study sought to determine the change in the rate of emergency department encounters related to child physical abuse. METHODS: A retrospective study within the Pediatric Emergency Care Applied Research Network Registry. Encounters related to child physical abuse were identified by 3 methods: child physical abuse diagnoses among all ages, age-restricted high-risk injury, or age-restricted skeletal survey completion. The primary outcomes were encounter rates per day and clinical severity before (January 2018–March 2020) and during the COVID-19 pandemic (April 2020–March 2021). Multivariable Poisson regression models were fit to estimate rate ratios with marginal estimation methods. RESULTS: Encounter rates decreased significantly during the pandemic for 2 of 3 identification methods. In fully adjusted models, encounter rates were reduced by 19% in the diagnosis-code cohort (adjusted rate ratio: 0.81 [99% confidence interval: 0.75–0.88], P <.001), with the greatest reduction among preschool and school-aged children. Encounter rates decreased 10% in the injury cohort (adjusted rate ratio: 0.90 [confidence interval: 0.82–0.98], P 5 .002). For all 3 methods, rates for lower-severity encounters were significantly reduced whereas higher-severity encounters were not. CONCLUSIONS: Encounter rates for child physical abuse were reduced or unchanged. Reductions were greatest for lower-severity encounters and preschool and school-aged children. This pattern calls for critical assessment to clarify whether pandemic changes led to true reductions versus decreased recognition of child physical abuse.
Original language | English (US) |
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Article number | e2022056284 |
Journal | Pediatrics |
Volume | 150 |
Issue number | 1 |
DOIs | |
State | Published - Jul 1 2022 |
Funding
This project work was supported by the Agency for Healthcare Research and Quality, grant number R01HS020270. Salary support for Dr Chaiyachati was provided by the National Institutes of Health/National Institute of Mental Health institutional training grant number T32 MH019112. PECARN is supported by the Health Resources and Services Administration (U03 MC33155) of the US Department of Health and Human Services, in the Maternal and Child Health Bureau, under the Emergency Medical Services for Children program through the following cooperative agreements: DCC-University of Utah, GLEMSCRN-Nationwide Children’s Hospital, HOMERUN-Cincinnati Children’s Hospital Medical Center, PEMNEWS-Columbia University Medical Center, PRIME-University of California at Davis Medical Center, CHaMP node-State University of New York at Buffalo, WPEMR-Seattle Children’s Hospital, and SPARC-Rhode Island Hospital/Hasbro Children’s Hospital. Funded by the National Institutes of Health (NIH). FUNDING: This project work was supported by the Agency for Healthcare Research and Quality, grant number R01HS020270. Salary support for Dr Chaiyachati was provided by the National Institutes of Health/National Institute of Mental Health institutional training grant number T32 MH019112. PECARN is supported by the Health Resources and Services Administration (U03 MC33155) of the US Department of Health and Human Services, in the Maternal and Child Health Bureau, under the Emergency Medical Services for Children program through the following cooperative agreements: DCC-University of Utah, GLEMSCRN-Nationwide Children’s Hospital, HOMERUN-Cincinnati Children’s Hospital Medical Center, PEMNEWS-Columbia University Medical Center, PRIME-University of California at Davis Medical Center, CHaMP node-State University of New York at Buffalo, WPEMR-Seattle Children's Hospital, and SPARC-Rhode Island Hospital/Hasbro Children's Hospital. Funded by the National Institutes of Health (NIH). CONFLICT OF INTEREST DISCLOSURES: The Children's Hospital of Philadelphia has received payment for the expert testimony of Drs Chaiyachati and Wood when subpoenaed for cases of suspected abuse. The remaining authors have no conflicts of interest to disclose.
ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health